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Alaska Dental Health Therapist Manager Wins National Award from IHS

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Kathy Balasko, manager of Alaska's dental health aide therapist program, run by the Alaska Native Tribal Health Consortium (ANTHC), recently received a high honor from the Indian Health Serivce (IHS) for leading a successful dental care program that serves some 35,000 Alaska Natives across the state—reaching many in very remote villages.

Balasko accepted the Senior Hygiene Clinical Service Award for Excellence at the National IHS Dental Update, held July 18-21 in in Albuquerque, New Mexico.

“Kathy is an invaluable resource for our dental disease prevention and oral health promotion efforts in Alaska,” said Mary Williard, DHAT training director, in a statement. “As a clinician, an educator, and program manager, Kathy has given remarkable energy and commitment to improving oral healthcare access in rural Alaska.”

The Bethel-based Dental Health Aide Therapist (DHAT) program delivers dental care to many Alaska Natives who might have otherwise gone without. In a recent op-ed, Mark Trahant praised the dental therapist program, citing dismal statistics regarding dental care access more than a decade ago: "A 1998 study by the SouthEast Alaska Regional Health Consortium showed that only 20 dentists were serving more than two hundred villages and some 85,000 people. Compounding that dentist shortage is rampant tooth decay among Alaska Natives; nearly 70 percent of children under 14 have dental caries (a bacteria process that causes decay) and more than 90 percent of adolescents show the disease."

Trahant explained that 10 years ago, ANTHC "began planning for a new dental health initiative, one modeled after the successful Community Health Aide Program. Then in 2003, six students traveled to New Zealand for a two-year training program as dental health therapists. That’s half the time it takes to train a dentist—and at a cost significantly less. Moreover, Murat and other Alaska Native dental health therapists are committed to working in villages, places where routine health care is absent. (Of course that’s true of most of Indian Country. We all know about how difficult it is to get an appointment with a dentist on a regular schedule.)"

Trahant continued: "Now the training is conducted by the ANTHC in partnership with the University of Washington at classrooms and clinics in Anchorage and Bethel. The Alaska program was unsuccessfully challenged by the American Dental Association (ADA)—and the ADA continues to block expansion to other reservations through a provision in the Indian Health Care Improvement Act."

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A dental therapist is not a dentist but more like a physician’s assistant or nurse practitioner. They are supervised by dentists, often remotely, by “teledentistry.” They are qualified to do preventative work, fillings and extractions, but not more complicated dentistry like crowns and root canals.

The W.K. Kellogg Foundation has started a $16 million project to pursue dental therapist programs in five states: New Mexico, Washington, Kansas, Ohio and Vermont. Other states are interested as well. However, a potential roadblock is in the mix, she said: “Tribes must secure state legal authority to implement therapist provider programs.”

Balasko began her IHS career in Alaska in September 2004, beginning with the Yukon-Kuskokwim Health Corporation (YKHC) in Bethel, where she worked as a clinician, educator and manager of YKHC’s Primary Dental Health Aide Program. In 2007, Balasko was recruited to oversee the installation of a temporary clinic in Bethel that would house the new DHAT training program. In 2008, the Bethel clinic moved to its permanent location, the Yuut Elitnaurviat Dental Training Clinic.

Balasko has also served as the chair of the Dental Academic Review Committee of the Community Health Aide Certification Board, the event coordinator for the Annual Alaska Dental Chief, Dental Prevention Coordinator and Dental Assistant Meetings, and has traveled around Alaska teaching the hygiene curriculum of the Expanded Function Dental Health Aide and the Primary Dental Health Aide courses.

“In a unique environment which has many barriers to care, Kathy efficiently oversaw the installation of a dental health aide therapist training clinic in Bethel,” said Sarah Shoffstall, DENTEX Clinical Site director. “Her clinical skills, organization and dedication to improving the oral health of Alaska Natives make her the perfect candidate for this award.”

Also recognized at the IHS Dental Update was Stephanie Woods, one of the first graduates of the DHAT program that trained in New Zealand and now practices for the Maniilaq Association in Northwest Alaska. She was awarded the People’s Choice Award for her table clinic on the Alaska DHAT program that highlighted the curriculum, certification process and practice of a DHAT.